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Sydney, Australia

Hamad N.,Royal North Shore Hospital | Hamad N.,University of Sydney | Hamad N.,Chronic Lymphocytic Leukaemia Australian Research Consortium CLLARC | Kliman D.,Royal North Shore Hospital | And 12 more authors.
British Journal of Haematology

Chronic lymphocytic leukaemia (CLL) occurs rarely with pregnancy and monoclonal B-Lymphocytosis (MBL) has not previously been described in this setting. CLL is predominantly a disease of the elderly and affects men twice as often as women and hence only an estimated 2% of patients are females of childbearing age. We identified only five reported cases of CLL in pregnancy in the literature. We describe two additional cases, plus three other women with CLL dealing with pregnancy-related decisions. We review the literature and discuss proposals for management and issues that arise in this relatively uncommon occurrence. In contrast to many other haematological malignancies where longer remissions are typically associated with a lower risk of relapse, most patients with CLL who require treatment will ultimately relapse with current therapy. This complex setting requires careful consideration and well informed patients to assist with decisions related to pregnancy. © 2014 John Wiley & Sons Ltd. Source

Nash M.,Sydney Eye and Hand Hospital | Nash M.,Drummoyne Day Surgery Center | Skippen B.,Royal Prince Alfred Hospital | Gal A.,Laverty Pathology | And 3 more authors.

To assess the role of routine histopathological evaluation of the lacrimal sac wall when performing dacryocystorhinostomy (DCR) surgery.Methods: A retrospective review was conducted of the histology findings in lacrimal sac biopsies, taken routinely, in an external-approach DCR series. This is a single surgeon (RB), single pathologist (AG) consecutive series. The histopathology reports were reviewed and collated. Each patients medical history and risk factors for malignancy were recorded. The surgeon documented any abnormal lacrimal sac appearance at the time of surgery.Results: No patient in this series of 245, in whom 254 histology specimens were taken, recorded a significant pathological result that was not anticipated from pre-operative assessment, or from the appearance of the lacrimal sac intra-operatively.Conclusion: The reported recommendation for routine histopathological evaluation of the lacrimal sac wall when performing DCR surgery is not supported by this consecutive series. The authors recommend histopathological evaluation only in the setting of pre-existing clinical suspicion of malignancy, or an abnormal intra-operative appearance of the lacrimal sac. © 2015 Taylor and Francis. Source

Kvannli L.,The Surgical Center | Benger R.,The Surgical Center | Benger R.,Macquarie University | Gal A.,Laverty Pathology | Swamy B.,The Surgical Center

Background: The senior consultants Ross Benger and Andrew Gal have been using en face frozen section histological margin control in removing cancer from the periocular region since 1985. The aim of this study was to determine the percentage of cases in which more than one resection was necessary in order to achieve clear margins. Methods: This is a retrospective study of patients treated at Drummoyne Eye Surgical Centre in the period 1999-2007, in whom removal of the eyelid cancer was decided to be with en face frozen section histological control. A record was kept of how many resections were necessary to achieve clear margins. Paraffin sections were subsequently examined for a final histopathological diagnosis. Results: Two hundred and fifty people were included in the study, of whom 204 had basal cell carcinoma (BCC) and 32 had squamous cell carcinoma (SCC). One hundred and twenty BCCs had a full-thickness eyelid "wedge" resection, of which 45% needed more than the standard two frozen sections taken to achieve clear margins. Eighty-four BCCs were removed using ring resection, of which 35.7% needed more than the standard initial resections (peripheral annulus and deep disc) to achieve clear margins. Conclusions: Our study showed that a significant percentage of BCC and SCC lesions needed further resection after the initial frozen section edge checks to achieve clear margins. Intraoperative presence of the histopathologist increased the likelihood of achieving clearance of the cancer at a single operating session. © 2012 Informa Healthcare USA, Inc. Source

Farrell C.-J.L.,Laverty Pathology | Kirsch S.H.,Saarland University | Herrmann M.,District Hospital of Bolzano
Clinical Chemistry and Laboratory Medicine

Folate deficiency has been linked to diverse clinical manifestations and despite the importance of accurate assessment of folate status, the best test for routine use is uncertain. Both serum and red cell folate assays are widely available in clinical laboratories; however, red cell folate is the more time-consuming and costly test. This review sought to evaluate whether the red cell assay demonstrated superior performance characteristics to justify these disadvantages. Red cell folate, but not serum folate, measurements demonstrated analytical variation due to sample pre-treatment parameters, oxygen saturation of haemoglobin and haematocrit. Neither marker was clearly superior in characterising deficiency but serum folate more frequently showed the higher correlation with homocysteine, a sensitive marker of deficiency. Similarly, both serum and red cell folate were shown to increase in response to folic acid supplementation. However, serum folate generally gave the greater response and was able to distinguish different supplementation doses. The C677T polymorphism of methylenetetrahydrofolate reductase alters the distribution of folate forms in red cells and may thereby cause further analytical variability in routine red cell folate assays. Overall, serum folate is cheaper and faster to perform than red cell folate, is influenced by fewer analytical variables and provides an assessment of folate status that may be superior to red cell folate. Source

Farrell C.-J.,Laverty Pathology | Herrmann M.,District Hospital of Bolzano
Best Practice and Research: Clinical Endocrinology and Metabolism

The demand for analysis of 25-hydroxyvitamin D has increased dramatically throughout the world over the past decade. As a consequence, a number of new automated assays have been introduced for 25-hydroxyvitamin D measurement. Automated assays have shown variable ability to meet the technical challenges associated with 25-hydroxyvitamin D measurement. Assays are able to meet performance goals for precision at high concentrations but fail to do so at low concentrations of 25-hydroxyvitamin D. The overall accuracy of automated methods has improved over recent years and generally shows good overall agreement with reference methods; however, discrepancies persist for individual samples. Liquid chromatography-tandem mass spectrometry is used by some routine laboratories for 25-hydroxyvitamin D analysis but its widespread use is hampered by limited sample throughput. 1,25-Dihydroxyvitamin D is an important analyte in specific clinical situations, which remains in the hands of specialised laboratories using manual analytical methods. © 2013 Elsevier Ltd. All rights reserved. Source

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